Approach

The second campaign was launched nationally in September 2017. This campaign focused on the importance of rapid HIV treatment and rapid testing after people have run the risk of an HIV infection. The campaign aimed to alleviate fears about a positive test result, by emphasizing that having HIV will only have a limited impact on a person’s future life and their sex life.

The campaign consisted of three components:

1. Videos that illustrate day-to-day situations in which MSM may find themselves, where an HIV-positive status and the benefits of treatment are presented in a normative and nonchalant manner. These videos helped to normalize and de-stigmatize HIV infection and its treatment.
2. The distribution of greeting cards and postcards that conveyed the message that you can live a healthy life with HIV if you start treatment early.
3. A website – Laatjesneltesten.nl – which offered more detailed information on the benefits of early treatment (cART) and the need for HIV testing as soon as possible after potential exposure. The website provided users with tailored advice on testing through a Risk Check, and linked users with different options for HIV testing according to the region in which they live.

Results

The campaign received national media coverage and the website was viewed more than 32,000 times. The risk check was completed more than 9,000 times. The ads and videos have been viewed more than 3 million times (January 1, 2018).

A baseline measurement was done before the campaign, and a new test took place after the campaign. About a third of the respondents who were included in the baseline measurement took part in the test afterwards. The number of respondents who considered it important to test for HIV as soon as possible increased by almost 19%. Second, we found an increase of 8.8% among respondents who find it very important to be treated quickly after an HIV diagnosis. Third, a 4.27% increase was found in not waiting for treatment after diagnosis. Of the respondents, 25.89% had seen the one night stand video and 42.39% the video about buying a house. It seems plausible that the campaign had a positive effect. It is plausible that the respondent group consisted of men who considered sexual health more important than the average MSM.

Approach

Now that HIV is no longer a deadly illness, but a chronic one, the question arises whether risk groups truly realize the implications of having HIV. For example, if HIV negative MSM underestimate the implications of HIV as a chronic illness, they will be less motivated to actively avoid acquiring the infection by using condoms or PrEP. We therefore wish to investigate whether such knowledge gaps exist, and if they do, to develop an intervention that will correct such beliefs and strengthen the motivation of MSM to avoid acquiring an HIV infection.

This campaign consists of two steps:

• Step 1:

For the first study, a qualitative study was carried out of the experienced consequences of HIV diagnosis and its perceived burden among MSM diagnosed as of 2014. The second study examined the perceived burden of HIV as a chronic illness among HIV negative MSM and the experienced burden of HIV as a chronic illness among HIV positive MSM.

• Step 2:

Based on findings from the first study, the H-TEAM will devise an HIV prevention intervention. The campaign will consist of a tailored intervention to counteract knowledge deficits and problematic perceptions regarding HIV as a chronic illness among HIV negative MSM. In this way we hope to improve the basic motivation to undertake protective measures to avoid acquiring an HIV infection.

Results

The qualitative part of the first study was concluded. We conducted 18 interviews among MSM with HIV diagnosed between 2014-2018. Results indicated that after a habituation period, several aspects of HIV infection remained burdensome among recently HIV infected MSM. These were primarily related to stigma and social experiences, next to some aspects relating to the treatment itself.

The quantitative part of the first study has been concluded as well. Based on themes that emerged from the qualitative investigation, two adapted questionnaires were constructed: one to measure burden among HIV positive men, and one to measure perceived burden among HIV negative men. The questionnaires were advertised online in gay social media and dating apps. A total of 1578 questionnaires were completed (449 HIV-positive men/1138 HIV-negative men). In order to determine which aspects of living with HIV are over- or underestimated by HIV-negative MSM another survey was conducted, which was completed by 1388 respondents (950 HIV-positive MSM/438 HIV-negative MSM).

The most important results of the study conclude:

• One-quarter of HIV-negative MSM did not perceive HIV as a severe illness, which was associated with more prevalent sexual risk taking. The anticipated burden consisted mainly of interpersonal aspects of living with HIV.
• HIV-negative MSM significantly overestimated the negative impact of living with HIV in 97% of the burden-related items. On items measuring general impact, HIV-negative MSM were more likely to anticipate deteriorating quality of life and feeling bad about having HIV, and were less likely to accept having HIV compared to HIV-positive MSM.

More research and further debate are needed on how to successfully communicate the disadvantageous aspects of having HIV without fueling HIV stigma and discrimination.

The full results of this research can be read in the following publications:

• Burden of living with HIV among men who have sex with men: a mixed-methods study.
• The Burden of Living with HIV is Mostly Overestimated by HIV-Negative and Never-Testen Men Who Have Sex with Men.
• Factors associated with Never Testing for HIV: Directions for Targeted Interventions Among Men Who Have Sex with Men.
• Prevention challenges with current perceptions of HIV burden among HIV-negative and never-tested men who have sex with men in the Netherlands: a mixed-methods study.